Transient Thyrotoxicosis Accompanied by Panhypopituitarism Caused by Ruptured Rathke's Cleft Cyst

Chung, Jin Ook; Cho, Dong Hyeok; Chung, Dong Jin; Chung, Min Young

doi:10.2169/internalmedicine.50.5693

Cited by 2 publications

(2 citation statements)

References 25 publications

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“…[ 15 , 16 ] Panhypopituitarism is rare in RCC though patients with symptomatic RCC usually have pituitary dysfunction of varying degrees. [ 17 – 19 ] In our case, the endocrine work-up results revealed panhypopituitarism resulting in adrenal insufficiency, hypothyroidism, and gonadal failure. Prompt replacement therapy with levothyroxine and prednisone significantly improved the clinical symptoms in our case.…”

Section: Discussionmentioning

confidence: 76%

Rathke cleft cyst masquerading as pituitary abscess

Yang

Bao²,

Liu³

et al. 2017

Medicine

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Background: Rathke cleft cyst (RCC) is a rare cystic sellar entity, which is usually small in size and asymptomatic in most patients. RCC presenting panhypopituitarism and a cystic lesion with rim enhancement on magnetic resonance imaging is extremely rare. Therefore, it is easy to be misdiagnosed as pituitary abscess because of the similar clinical manifestations and neuroimaging changes.Case summary: We report a rare case of RCC masquerading as pituitary abscess clinically and radiologically with no evidence of central nervous system infection. The patient was initially suspected to be diagnosed with pituitary abscess, which was denied by the histopathological findings of RCC with no intraoperative drainage of abscess.We present an uncommon case of RCC masquerading as pituitary abscess in a 62-year-old Chinese male patient. The patient was admitted to Peking Union Medical College Hospital complaining of severe frontal pulsatile headache, visual acuity deficit, polyuria, polydipsia, and slight disturbance of consciousness. The biochemical and endocrinological examinations revealed severe hyponatremia and panhypopituitarism. Magnetic resonance imaging showed a sellar lesion with the apparent cystic change and rim enhancement. Accordingly, pituitary abscess was misdiagnosed at the beginning.The patient received hormone replacement therapy and underwent a trans-sphenoidal surgery. The surgical findings were uneventful. The histopathological examinations showed no infiltration of inflammatory cells or pus, and proved the lesion to be RCC.Conclusion: Through this rare case, we aim to emphasize that the differential diagnosis of sellar lesions requires constant vigilance and that RCC may lead to clinical and radiological changes similar with pituitary abscess.Abbreviations: DWI = diffusion-weighted image, Gd-DTPA = gadolinium-diethylene triamine pentaacetic acid, MRI = magnetic resonance imaging, PUMCH = Peking Union Medical College Hospital, RCC = Rathke cleft cyst, T1WI = T1-weighted image, T2WI = T2-weighted image, VA = visual acuity.

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Section: Discussionmentioning

confidence: 76%

Rathke cleft cyst masquerading as pituitary abscess

Yang

Bao²,

Liu³

et al. 2017

Medicine

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“…In the English literature, there have been thirteen case reports of thyrotoxicosis complicated with hypercalcemia and adrenal failure [ 7 , 12 – 21 ]. The general characteristics, biochemical findings, and clinical course of patients are summarized in Tables 1 and 2 .…”

Section: Discussionmentioning

confidence: 99%

Life-Threatening Hypercalcemia due to Graves’ Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

Özkaya

Keskin

Haliloğlu

et al. 2015

Case Reports in Endocrinology

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A 47-year-old woman presented with the complaints of nausea, vomiting, and weight loss. She had a history of bilateral surrenalectomy due to Cushing's syndrome. On examination she had tachycardia and orthostatic hypotension. Laboratory examinations revealed hypercalcemia and suppressed parathyroid hormone levels. She also had thyrotoxicosis due to Graves' disease. The investigations to rule out a malignancy were negative. With steroid, zoledronic acid, and antithyroid drug treatment her symptoms were resolved and calcium level was normalized. This case highlights the importance of recognizing thyrotoxicosis and concomitant adrenal failure as a possible cause of severe hypercalcemia.

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Transient Thyrotoxicosis Accompanied by Panhypopituitarism Caused by Ruptured Rathke's Cleft Cyst

Cited by 2 publications

References 25 publications

Rathke cleft cyst masquerading as pituitary abscess

Rathke cleft cyst masquerading as pituitary abscess

Life-Threatening Hypercalcemia due to Graves’ Disease and Concomitant Adrenal Failure: A Case Report and Review of the Literature

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